Provider Demographics
NPI:1528409851
Name:CENTER FOR CHANGE AND GROWTH, LLC
Entity Type:Organization
Organization Name:CENTER FOR CHANGE AND GROWTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-390-6925
Mailing Address - Street 1:2975 E HILLCREST DR STE 406
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3181
Mailing Address - Country:US
Mailing Address - Phone:805-390-6925
Mailing Address - Fax:
Practice Address - Street 1:2975 E HILLCREST DR STE 406
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3181
Practice Address - Country:US
Practice Address - Phone:805-390-6925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder